Active NPI
Lisa Louise Hazelwood, PH.D.
- Clinical Psychologist
- Rancho Cucamonga, CA
National Provider Identifier
1801196027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 23776
- Practice address
- 9500 Etiwanda Ave., West Valley Detention Center
Attn: Medical Srvcs/Liberty Roc
Rancho Cucamonga, CA 91739 - Phone
- (909) 463-5115
- NPI assigned
- Oct 22, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 23776 | CA | Primary |
Addresses
Primary practice location
9500 Etiwanda Ave., West Valley Detention Center
Attn: Medical Srvcs/Liberty Roc
Rancho Cucamonga, CA 91739
Mailing address
PO Box 5488
Pasadena, CA 91117-0488
Phone (806) 535-5893
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23776 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380326400000",
"number": "1801196027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5488",
"city": "PASADENA",
"state": "CA",
"postal_code": "911170488",
"telephone_number": "806-535-5893",
"fax_number": "626-737-8384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 ETIWANDA AVE., WEST VALLEY DETENTION CENTER",
"address_2": "ATTN: MEDICAL SRVCS/LIBERTY ROC",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "91739",
"telephone_number": "909-463-5115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAZELWOOD",
"first_name": "LISA",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-22",
"last_updated": "2013-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "23776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.